From the Guidelines
The management of ground glass hepatocytes in hepatitis B infection primarily involves antiviral therapy with medications such as entecavir (0.5-1mg daily), tenofovir disoproxil fumarate (300mg daily), or tenofovir alafenamide (25mg daily) to suppress viral replication and prevent progression to cirrhosis, liver failure, and hepatocellular carcinoma.
Treatment Approach
The treatment approach should be based on HBV DNA levels, ALT levels, HBeAg status, and the presence of liver fibrosis or cirrhosis 1.
- For HBeAg-positive patients with elevated ALT levels and HBV DNA levels of 2000 IU/mL or higher, treatment with entecavir, tenofovir, or peginterferon alfa-2a is recommended 1.
- For patients with HBV DNA levels below 2000 IU/mL and normal ALT levels, monitoring every 6-12 months is suggested, with consideration of therapy in patients with known significant histologic disease 1.
Monitoring and Follow-up
Regular monitoring is essential, including:
- Liver function tests every 3-6 months
- HBV DNA levels every 3-6 months during treatment
- Periodic assessment for hepatocellular carcinoma with ultrasound every 6 months in high-risk patients Ground glass hepatocytes, visible on liver biopsy, represent hepatocytes with cytoplasmic accumulation of hepatitis B surface antigen (HBsAg) and indicate chronic HBV infection with active viral replication 1.
Goals of Therapy
The goal of treatment is to prevent progression to cirrhosis, liver failure, and hepatocellular carcinoma by suppressing viral replication, reducing inflammation, and potentially achieving HBsAg clearance, though complete cure remains challenging due to the persistence of covalently closed circular DNA (cccDNA) in hepatocytes 1.
From the FDA Drug Label
The recommended dose of entecavir tablets for chronic hepatitis B virus infection in nucleoside-inhibitor-treatment-naïve adults and adolescents 16 years of age and older is 0.5 mg once daily. The recommended dose of entecavir tablets in adults and adolescents (at least 16 years of age) with a history of hepatitis B viremia while receiving lamivudine or known lamivudine or telbivudine resistance substitutions rtM204I/V with or without rtL180M, rtL80I/V, or rtV173L is 1 mg once daily Entecavir tablets are indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease
The management and treatment of ground glass hepatocytes indicative of hepatitis B infection is with entecavir tablets. The dosage is as follows:
- Nucleoside-inhibitor-treatment-naïve adults: 0.5 mg once daily
- Adults with a history of hepatitis B viremia while receiving lamivudine or known lamivudine or telbivudine resistance substitutions: 1 mg once daily It is essential to monitor hepatic function closely with both clinical and laboratory follow-up for at least several months in patients who discontinue anti-hepatitis B therapy 2.
From the Research
Ground Glass Hepatocytes Diagnosis and Treatment
- Ground glass hepatocytes are classically associated with chronic hepatitis B (HBV) infection, storage disorders, or cyanamide therapy 3.
- In cases where the etiology cannot be identified, ground glass hepatocytes can also be seen in patients with polypharmacy, particularly those with a history of organ transplantation and/or malignancy 3.
- The presence of type II ground-glass hepatocytes is associated with an increased risk of hepatocellular carcinoma (HCC) in chronic HBV infection, and is also linked to advanced fibrosis 4.
Management and Treatment of Ground Glass Hepatocytes
- For patients with chronic HBV infection, antiviral treatment with either pegylated interferon or a nucleos(t)ide analogue (such as lamivudine, adefovir, entecavir, tenofovir disoproxil, or tenofovir alafenamide) is recommended to reduce liver inflammation and fibrosis 5.
- Nucleos(t)ide analogues are considered first-line therapy due to their reduced risk of drug resistance compared to older agents 5.
- Treatment should be offered to patients with chronic HBV infection and liver inflammation, with the goal of reducing progression of liver disease 5.
- In cases where ground glass hepatocytes are associated with polypharmacy, management may involve adjusting or discontinuing certain medications 3, 6.
Histological and Ultrastructural Findings
- Ground glass hepatocytes are characterized by pale pink, oval to crescentic intracytoplasmic inclusions that are intensely positive on periodic acid-Schiff stain and digested with diastase 3, 6.
- Electron microscopy shows non-membrane-bound cytoplasmic collections of granules with mild-to-moderate electron density, consistent with abnormal glycogen granules 3, 6.
- The inclusions are composed of abnormal glycogen and closely resemble polyglucosan bodies described in humans, animals, and experimental models 6.